title: Salivary cortisol output before and after cognitive behavioural therapy for chronic fatigue syndrome.
abstract: BACKGROUND
  There is evidence that patients with chronic fatigue syndrome (CFS) have mild hypocortisolism. One theory about the aetiology of this hypocortisolism is that it occurs late in the course of CFS via factors such as inactivity, sleep disturbance, chronic stress and deconditioning. We aimed to determine whether therapy aimed at reversing these factors--cognitive behavioural therapy for CFS--could increase cortisol output in CFS.
  
  
  METHODS
  We measured diurnal salivary cortisol output between 0800 and 2000 h before and after 15 sessions (or 6 months) of CBT in 41 patients with CDC-defined CFS attending a specialist, tertiary outpatient clinic.
  
  
  RESULTS
  There was a significant clinical response to CBT, and a significant rise in salivary cortisol output after CBT.
  
  
  CONCLUSIONS
  We were unable to control for the passage of time using a non-treated CFS group.
  
  
  CONCLUSIONS
  Hypocortisolism in CFS is potentially reversible by CBT. Given previous suggestions that lowered cortisol may be a maintaining factor in CFS, CBT offers a potential way to address this.
authors.affiliation: King's College London, Institute of Psychiatry, Department of Psychological Medicine, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Amanda D L
authors.initials: AD
authors.lastname: Roberts
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Papadopoulos
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
authors.forename: Trudie
authors.initials: T
authors.lastname: Chalder
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Cleare
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000097:blood / Q000523:psychology / Q000628:therapy; D015673:Fatigue Syndrome, Chronic / Q000097:blood / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012463:Saliva / Q000737:chemistry; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D006854:Hydrocortisone